Provider Demographics
NPI:1538251285
Name:ALTIG, WILLIAM DROST (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DROST
Last Name:ALTIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 WESTERN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-3101
Mailing Address - Country:US
Mailing Address - Phone:817-847-0030
Mailing Address - Fax:817-847-1478
Practice Address - Street 1:3451 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-847-0030
Practice Address - Fax:817-847-1478
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3438TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0192262-01Medicaid
TX80836EOtherBCBS PROVIDER NUMBER
TX80836EOtherBCBS PROVIDER NUMBER
TX8F21908Medicare PIN
TXMA0267143OtherDEA NUMBER
TXB23189Medicare UPIN